Category Archives: therapy

So, on the way home from therapy on Tuesday I took an overdose of Ativan. The session itself was difficult, as we discussed my recent suicide attempt and the fact that I found a new therapist and would like to start seeing him next month. I also tried to ensure my therapist that the events are mutually exclusive. ( I thought this was very important.) In other words, I’ve been contemplating a change in therapists for some time now (which is true).

Furthermore, I was dreadfully scared of having to go back to work yesterday, so instead of addressing it proactively–by either talking to my therapist or boss, trying to go on disability or something, etc.–I felt it best to OD. That will grab attention, I thought; and it sure did.

Without doing much damage I skipped the emergency room and went right to my psychiatrist’s office. He suggested I spend the night somewhere safe at a urgent care clinic, which I did (which wasn’t so bad), and then possibly go on disability leave from my job. There’s also plenty of options for low-cost inpatient care treatment here in San Francisco (we love our social services here!), so that’s an option. But to be honest, I really think I just want to switch anti-depressants–to Nardil–and go back to my normal routine.

I’m proud of myself because I told both my parents what’s been going on with me over the phone, and they were both very supportive. I also texted my boss. I haven’t given him all the details yet–I just told him I couldn’t come in because I had a psychiatric emergency. He’s provided support, and he wants me to call him–and I will as soon as I get up the courage.

I am feeling loads better. I see my psychiatrist again today to hopefully get on Nardil. I am also no longer feeling suicidal. Yay!

So, since my therapist is out of town this week we arranged to have our regular session over the phone yesterday. I was dreading the session most of the day, even more than usual actually because I don’t like talking on phones. I don’t like checking voice mail. I don’t like seeing/hearing others talk on their phones. I don’t like hearing them ring (or vibrate, in my case). I cringe when I hear other people’s phones ring. I’d get rid of mine, but that probably wouldn’t be smart for someone with social anxiety.

It must have something to do with the fact that there are no distractions over the phone. It’s me and the other caller–that’s it. There is no one else to take the spotlight off me. There are no external distractions either, like television or eating or music or a movie, etc. But there are no distractions like that in therapy anyway, so I don’t know what I was so afraid of.

Anyhow, about thirty minutes before the session started, tension, nervousness, and anxiety hit. I just wanted to get it started (or over with). My stomach hurt, and I began sweating a little under my arms. I felt like I was getting ready to go to a large social gathering or something. I think it must have been the combination of the phone and pre-therapy jitters.

I’m probably freaking out about nothing, I told myself. So I’m going to stop indulging in my negative thoughts. Once I became aware of what was happening and told myself to stop, I felt better.

***

The session started like all our other sessions. We talked a little about how this–therapy over the phone–is new territory for us and what not. I wish we would have explored my phone-phobia a little more. I brought it up, but we quickly turned to other things.

I told him about how I was feeling anxious about Christmas, about how I’d be seeing my relatives. I told him how anxious I felt as soon as I found that out. We spoke about this for a while (mostly about how I’m afraid of interacting with my cousins’ children) before he said–

“You can push back if you want but what I think it all comes back to is self-acceptance. It’s okay to be introverted and reserved. It’s okay to be soft-spoken. But these things are not okay for you.”

He went on and on, and yet I was still stuck on his words push back. It had a negative connotation to it. To me, the words said–

Now you can push back, but if you do, you will be wrong because I am the therapist and I am right.

After he got done talking about self-acceptance, we were both silent.

“Where are you?” he asked, finally breaking the silence.

I told him the truth. I told him how I didn’t hear much of what he said because I was still stuck on him saying push back. I told him how I’m uber sensitive to his wording sometimes and how I’m afraid to stop him because I’m afraid he’ll say I’m just avoiding things (like he’s done in the past). We had a good discussion about that, and I feel a little better about it, actually. I think he understands better that when I do stop him, sometimes it’s not that I’m avoiding–it’s just that I want to say something and that should be okay. I don’t think there has to be a hidden/deeper meaning in everything.

One thing interesting that he did mention is that therapy is the one place where I can–and should–feel comfortable pushing back. A lot of times in life, I want to do that, but I just don’t have the self-esteem.

We then went on and talked more about the letter (part 1, part 2) I sent to my parents and how I can use that to start more discussions. I’m scared to talk more about it, yet I do want a closer relationship with my parents. I know my relationship with them hasn’t changed because of one letter. I have to keep moving forward, and I feel a lot of pressure to do that.

Finally, at the end of the session, I started getting flooded with anxiety, as I always do, and I checked out by browsing Facebook. When we finally said goodbye, I found myself looking at pictures of someone from high school who used to pick on me. Whenever I get on Facebook I’m unconsciously brought to the people who did me harm. I should probably bring that up in a future session, among other things. I’ll add it to the list.

I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost … I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter 2

I walk down the street.
There is a deep hole in the sidewalk.
I pretend that I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But, it isn’t my fault.
It still takes a long time to get out.

Chapter 3

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in … it’s a habit … but, my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter 4

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter 5

I walk down another street.

***

I love that poem. It’s from There’s a Hole in My Sidewalk by Portia Nelson. I feel like each chapter represents a stage of my recovery.

Chapter 1 encompasses my middle school and high school years, when social anxiety began to develop. I started avoiding social interaction by ending friendships and isolating myself; developing powerful, yet irrational beliefs and attitudes; and reinforcing those same beliefs and attitudes with my thoughts and actions–all while being unaware.

The years (early college) which make up Chapter 2 are even harder than the previous years, as I’m in denial. I know that I am an introvert and highly sensitive, yet I know there’s much more to it than that. That is, I know there’s some deeper issues. I avoided them by locking myself in sexual relationships, avoiding friendships, and abusing alcohol. I was absolutely miserable, yet I put up a happy, normal facade. I hid my problems well, and that’s the only way I knew how to cope–because I didn’t know what was wrong or where to seek help.

Chapter 3 represents my latter college years and the year I spent in New York after graduation. By that point I knew I suffered from Social Anxiety Disorder. I knew I kept people at a distance because I was afraid of what they may see inside. And I knew I needed to seek professional help, but I didn’t. Again, I coped by drinking and denying; however, those tactics began to lose their power because I knew there was a deeper issue.

Today, I’m somewhere after chapter three but before five. (I don’t want to say I am in Chapter 4 because sometimes I feel like I’m beyond it and sometimes I feel like I’m not even there yet). I am seeking professional help. I am aware of my thought processes and where they can take me. I know not everybody is a fan of CBT–or its wording and metaphors–but it has greatly helped me. I know, for instance, that certain thoughts will lead me down familiar roads, and I know at the end of those roads, there is nothing good there. I know that if I continue to take those roads, I will continue to feel a certain way. I haven’t totally changed my habits, but I am getting closer. I think Chapter 5 is in sight.

Now, for those who are at an earlier stage, there is no shame, because how you are feeling is not your fault. You are not explicitly choosing to feel anxious or depressed. We’re all at different stages, and we’re all in this together. What’s more, recovery is not linear. You don’t go from bad to good to better to best. Sometimes I’m in Chapter 4; other times I move back to Chapter 2–but, in the end, I am moving forward. More and more of my time is spent in the latter Chapters.

Again, my seemingly non-productive therapy session has turned into quite a lot of introspection. It prompted quite a few questions, and maybe a few shifts. It’s amazing how simple shifts (and insights) can seem like nothing–on the outside, to anyone else–but they can make a world of difference. Essentially, not a lot happened during therapy on Tuesday, but since then, I’ve been thinking a lot about the few things that did happen. I started writing a post briefly detailing each one, but I want to step back and hash each one out. So I’ll be recapping therapy for the next few posts.

***

First, today is the last day of the semester. I had to half-ass a paper, which is not my style (and honestly it felt good to turn it in incomplete [really jabbing my perfectionist side]), but other than that, I got everything done. I’m now left with a month and a half break before the start of the next semester, and I’m a little worried about how I’m going to spend this break.

What am I going to do with myself?

I am going to Kansas City, to visit my family, for 11 days around Christmas, which will probably be stressful, but at least I’ll get some social interaction.

That’s exactly what I’m worried about this next month: social interaction. Even though I am going to school online, just interacting in that format–message boards, conference calls–is better than nothing.

What’s more, my girlfriend and I have been entertaining the prospect of moving as of late to save money, live closer to the train, and to have roommates (so we can both be a little more social). I’m all for having roommates, but I hate the stress of moving, and I don’t want to be tied down by a new lease. So, I’ve been resistant. Anyway, on Tuesday night my girlfriend, frustrated with me, called me a hermit, which I did not appreciate.

I do things. I have (a few) friends I talk to (mostly online). I go out and buy groceries and go to the library and volunteer. I’m sure there’s more.

That said, it really ticked me off because there is a part of me that is afraid that she is right. Maybe I am becoming a hermit. I may not be there yet, but I’m slowly pushing people away and becoming more and more isolated. I’m scared.

At least I’m aware now and, hence, can make changes. I’d like to spend this break reading, writing, and running, but I probably should do some volunteering, (re)connecting with friends, and hanging out with my girlfriend’s family as well. Maybe I’ll join Toastmasters.

For longer posts, dealing more with theory, I usually start writing them three or four days, sometimes weeks, before I post them. I have an idea in mind, and I like to watch it grow, like a piece of art. As of late, though, my moods have been fluctuating so much that I often times abandon my original idea altogether or change it so much that it barely resembles its original form–which is the case for this post (the latter issue, that is).

***

Put simply, I had to give two class presentations this past week. One on Thursday, and the other on Sunday. I haven’t had to do any sort of public speaking in over a year, so I clearly was very nervous/anxious going into it. I decided to try to get some of my thoughts out to help not only understand the anxiety (and where it’s coming from), but alleviate it as well. What you’ll soon find out is that the presentations went well. Sure, I was nervous, but I did fine, probably better than most people, in fact.

Anyway, here are some highlights–

Anticipatory anxiety hit me on Wednesday: I feel like shit. My stomach is tense and wound up in a knot. I’m having trouble swallowing. I’m sweating. I feel like I should take an Ativan or something, but I sort of feel like I’m becoming dependent on them. But none of my relaxation strategies are working. I’m sick (with a cold), so I can’t go running. I don’t know what to do.

Honestly, I’m mostly worried about the questions after the presentation. What if I won’t be able to answer them because I’m flooded with anxiety? What if I sound nervous? What if I fail?

I eventually calmed down, but anticipatory anxiety returned before my presentation (no surprise there): My presentation is in less than 3 hours. I’m in denial (sort of). I just ate, took an Ativan (1mg) and a Propranolol (10mg), and went over my presentation again. My stomach is tense. I’m sweating pretty bad, especially under my arms, and I feel an impending doom. I know the negative thoughts are hidden under this doom, but I’m scared to see what’s under there. I wish I had therapy tonight–and I wish even more that I hadn’t skipped therapy on Tuesday (because I was/am sick).

Again, the presentation went fine: It’s over. It didn’t go bad at all. I got hung up on one question, but overall, it went really well. I feel stupid for making a big deal out of nothing. About five minutes before the presentation started, I chatted with the professor and the other students. I then stood up, shook my body all over, and then went to the mirror and smiled (to make sure I still could). This helped to calm me down. I can now strip off my sweat-stained undershirt and move on.

Anticipatory anxiety started again on Sunday, about seven hours before my next presentation. I’m starting to feel a bit nervous. I feel that impending doom again. It’s scary because I don’t know what lies beneath. It’s unknown. Thoughts, on the other hand, are tangible, while this feeling is not. I can hold thoughts. I can touch them. They are real. But I’m too scared to find those thoughts.

Then two hours before the presentation depression hit: I’m depressed, and I DON’T GIVE A SHIT ABOUT THE PRESENTATION. I don’t know where these feelings came from or why I’m having them. Maybe they’re connecting with this doom feeling?

The depression wore off for the presentation, leaving me with anxiety, but it came back immediately after: Well, the anxiety pushed the depression into the background. I took an Ativan (1mg) before the presentation. Again, the presentation went well, and, again, the anticipatory anxiety was much worse than the actual presentation. I feel good about the week, but depression is hitting me again. I’m scared.

***

By the end of the night I was really low. I binged on food, drank a big beer, and had a cigarette (the first one since the wedding)–nothing helped. I woke up feeling even lower. What’s going on? I asked myself. I had a fairly good week. I mean, I not only got through the presentations, I did really well. I should be feeling good. I should be feeling great. As always, though, there’s much more going on than what meets the eye.

Actually, depressions usually hit me after successful social situations because that part of me that wants to be messed up–that part that likes having social anxiety, that part that I know, that part of me I think is me–flexes his muscle and brings me down. He, my anxiety, wants to maintain control. Does that makes sense? However, I still think there’s more there.

As some of you know, I’ve been dealing with this question as of late–Without social anxiety, who am I? The answer is a resounding I DON’T KNOW!, which is exactly why I’m so scared to find out, which is exactly why I sometimes like my anxiety–and even fuel it. My illness is warm and fuzzy; it’s familiar; in some ways, it’s all I know about myself.

There’s also my perfectionism, my need to always be perfect. I can’t make mistakes. I can’t have any flaws. I have to anticipate every move. I have to always be on the guard. And yet, perfectionism, is about mistakes, because a perfect human is flawed. Thus, by not allowing myself to make mistakes, I prevent myself from not only being perfect, but knowing what it means to be truly human. There is a part of me that does want to let go, but I’m still wrestling with the question of what exactly that means–and how to go about doing it when all I know is rigidity and repetition and compulsion.

But maybe I got a glimpse of what it was like to not be hindered so much by anxiety or my perfectionism this week? I engaged with people and was able to give two presentations without feeling too much anxiety. I also let go (somewhat) during them. I allowed myself to fail a bit on the question and answer section afterward. I could of been more thorough. I could have answered them better. But, frankly, I didn’t give a shit. I also have a huge, 15-page paper–30% of my grade–due on Thursday that I haven’t even started–and, again, I don’t give a shit.

I’m wondering, am I feeling depressed because I’ve seen a glimpse of myself in a new light–without so much anxiety and perfection–and not liked what I saw? Or is my ego (my anxiety) just flexing it’s muscle, wanting to maintain control?

***

Finally, without my anxiety, I’ll have to deal with deeper issues–

I really hate this system I’m living in. As reminded here, we’re just living a joke (capitalism) and our lives are the punch lines.

Here, I’m left with the difficult question of how do I fill this void inside of me? I’m continually looking to the future for happiness. That is, my next goal, my next achievement, my next cure, etc. What happens when there is nothing left to cure? What happens when I actually have to start living, and what if I really don’t believe there is any point to living besides not dying?

Finally, here I’m reminded that these feelings I’m having are temporary. In fact, I’m feeling much better now–but even that is temporary.

How did I know that someday–at college, in Europe, somewhere, anywhere–the bell jar, with its stifling distortions, wouldn’t descend again? ~Sylvia Plath, The Bell Jar

So, even though I haven’t talked much about it, I see a hypnotherapist once a month. In fact, I think this is the only post where I’ve mentioned it.

Anyway, so I used to see her–my hypnotherapist–once a week, but a few months ago I went down to every other week, and after last session we agreed to just once a month. It’s expensive, and I honestly don’t get much benefit out of it. It’s hard for me to relax and really get into the sessions. I get much more out of meditating on my own. That said, she is recovering from social anxiety herself, so I enjoy talking with her, as I know she knows exactly what I’m going through. She gives me the empathy that I’m missing from my talk therapist.

Also, she has encouraged me to do CBT therapy, and has provided me with materials, and so she sort of keeps me accountable. I update her once a month on my progress, in other words.

***

Last week she emailed me, asking me to write down every single social interaction that went well for me. For the most part I’ve been doing that (in the Achievements section), but she had me document everything, no matter how small. So, if I bumped into my neighbor and smiled and said hello or something, I’d make a note of it. It surprised me just how many interactions I had. I am much more social than I thought, even though I still feel isolated. It’s just the social interactions I do have are very superficial, aside for with my girlfriend. I’m missing deeper connections. But that’s no surprise.

So in yesterday’s session, we talked about that for a while, and then we got on the subject of the wedding from a few weeks back, and we decided it would be best to do a hypnosis around it–even though I am feeling much better about it (time heals all wounds, I guess).

Anyhow, she guided me into a relax state by having me focus on my breathing–slow, deep breaths, inhale five seconds, exhale ten. My thoughts are usually elsewhere at that point–e.g., making to do lists, thinking about future social situations–but yesterday, I let them float on like clouds, not letting them take me. I stayed present, in my body.

She then had me visualize my inner self, as a healing light. Viewing myself like this, I pictured the “true” me, not the me with anxiety, not the me happy or sad–but the me, that just is. The me that has worth for just being me.

Next, she had me visualize a specific social situation from the wedding that didn’t go well for me. I immediately pictured a one-on-one conversation I had with my girlfriend’s brother-in-law. We talked for like thirty minutes at the dinner table. It was very awkward. I was a mess. I was sweating and slightly shaking. I couldn’t sit still. Meanwhile, he looked as if he didn’t want anything to do with me. He kept looking around (maybe trying to find someone else to join in or for him to escape to) and he didn’t really offer anything to the conversation. I don’t know. It’s hard for me to describe. He just didn’t give off the vibe like he wanted to talk to me. But then again, I probably didn’t either, because I didn’t want to be there in the first place.

Anyway, in the hypnosis, my therapist had the present inner me–this healing light–approach myself, in that awkward social situation. This light pulled me aside, taking me away from the conversation and the wedding itself.

“What would you say to yourself now,” she asked rhetorically, “to calm yourself down and make yourself feel better in that moment?”

She paused for several minutes to let the question sink in. Eventually, I answered it internally–

“It’s okay,” I’d say. “It’s not the end of the world that you’re feeling so anxious; everybody probably feels a little anxious–but it’s okay that you’re feeling more anxious. People are so wrapped up in there own anxieties and issues (and the bride and groom) that they probably don’t notice you, or your anxiety, at all. I know it’s hard, but you’re here. You’re not hiding in the bathroom or fleeing. You’re here, facing your fears, and that’s an accomplishment in itself.”

Afterward, I kept visualizing this inner, healing light. I could almost feel it all around me, touching me. When she brought me out of the hypnosis, I felt calm, collected, and grounded. I felt at peace.

Over the next few days she wants me to continue to think of those rational thoughts I told my other self at the wedding, to help them sink deeper into my brain. I wish I would have seen her directly after the wedding, when I was really depressed and could only see the negative aspects. Maybe next time I’ll be able to use this strategy in the event. That is, I’ll be able to step back and gain perspective to help ease some of the anxiety.

Why are pdocs always late? I’m always having to wait at least fifteen minutes after our scheduled appointment time. It’s not fair. Because of I was late like that, I would probably get a lecture on the importance of being on time. It throws my day and all my structure off. On days I have to see him, I can never plan for anything after. Anyway this time I decided to say something–

“Right on time, as usual,” I said, quite passively. His non-response indicated that he didn’t appreciate my sarcasm.

I had high hopes for the session. I wanted to drop the other medications I’m on–Lamictal and Klonopin–and start taking Nardil, as a friend of mine with social anxiety has found Nardil quite helpful. The problem was/is that my pdoc hasn’t prescribed Nardil in over twenty years as he had a patient almost die while on it. You see, there are some dangerous food interactions, particularly alcohol, cheese, aging fruits and vegetables, some meats, soy, and so on. It’s quite alarming. You could eat the wrong kind of cheese and end up in a hypertensive state and have a heart attack.

But if the ends justify the means, I think I can live with the reduced diet–and the risks. My pdoc, however, wants to exhaust all other options first. So, he increased my dose of Klonopin and added Xanax into the cocktail (both of which, I might add, I’m having trouble filling due to insurance restrictions–so frustrating). Anyway, I came out of my appointment disappointed.

Oh, and I also got lectured.

My perfectionism came up. I told him I’m frustrated because I don’t have many friends, and outside of my relationship, I pretty much only hang out with my girlfriend’s family. And since she has a large family, I pretty much bounce from one large group social gathering to the next. I don’t believe that type of exposure works. I need gradual exposure. I need to see small successes and build from there. I won’t get any better if I continue going to huge social gatherings. But I don’t feel like I can opt out of them, either. Otherwise, I would just sit around the apartment, isolated.

“It’s okay to avoid things,” he said. “In fact you need to take back control from your anxiety and start saying ‘NO!’ every now and then.”

“But then I’ll be completely isolated,” I said.

“You’re going to school, you’re starting an internship, you have a girlfriend–you don’t sound isolated to me.”

“I’m going to school online,” I countered, “which isn’t helping my anxiety. I’m scared to death of the internship. I’m too dependent on my girlfriend.” We sat in silence for some time. “I can’t help but think this way. I know my perfectionism is fueling my anxiety but I can’t control it.”

“Mike, it’s not perfectionism. It’s punishment. You’re punishing yourself for not being perfect, and by doing so, you’re giving control to your pain. You still have control, though, but you don’t feel like you have it anymore, because these beliefs of yours are so ingrained. I don’t think you’re challenging your beliefs enough.”

I’ve been in therapy for over a year–is that not enough? But he’s right. I do not feel like I have control. I feel like I am my anxiety. I am my beliefs. I am who I say and think I am. How does change occur, though? It’s easy to intellectualize this process, but that can only take me so far. Change is deeper, in areas that I don’t like to touch. In areas I don’t know how to touch. When I do touch them, I shut down, I get flooded, and I push away.

He also brought up the issue of learned helplessness. I’ve failed so many times in the past, I do not believe I can succeed. I’ve taught myself how to fail. I’ve let my anticipatory anxiety get the best of me. I think I’ll fail, therefore I will fail. But maybe–just maybe–being conscious of this will help me change? I hope so.

***

Later on in therapy that night, my therapist asked, “What does it mean to be perfect? What does perfectionism mean to you.”

“It means I avoid being judged negatively,” I said.

There’s more but I don’t feel like typing it out. It was a tough session, to say the least. He pushed right up against my beliefs, and I pushed right back, shutting down in the process. I feel like we’ve been at a standstill for some time now. Why does change have to happen so slowly?

I am Mike. As of writing, I suffer from Social Anxiety, Depression, Perfectionism, and Disordered Eating, among other things. I like to think this blog is my journey toward personal understanding, and each day I get a little closer to being able to name the experiences going on inside my body.